Li Xinyuan, Zhu Lijun, Su Yingying, Fang Shaokuan
Department of Neurology, Neuroscience Centre, the First Teaching Hospital of Jilin University, Changchun, China.
China-Japan Union Hospital of Jilin University, Changchun, China.
PLoS One. 2017 Oct 5;12(10):e0185865. doi: 10.1371/journal.pone.0185865. eCollection 2017.
Although efficacy of venlafaxine extended release (XR) for generalized anxiety disorder (GAD) has been reported in previous analyses in 2002 and 2004, the sample size was rather small and estimate of safety or tolerability was not clear. The present analysis had the advantage of large sample size and provided evidence for tolerability.
Literature databases were searched, including Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of science and clinical trials. 10 eligible articles were finally selected and data was extracted and logged into the Review Manager 5.3 by two independent authors. The risk of bias was evaluated by the Cochrane Collaboration's Risk of Bias Tool and the stability of the results was assessed by sensitivity analysis. The publication bias was assessed by funnel plot and Egger's/Begg's test using Stata Version 12.0 software.
In the current meta-analysis, 10 articles (14 studies) satisfying the inclusion criteria were analyzed. As efficacy outcomes, our findings indicated venlafaxine XR was significantly more effective than placebo according to mean change of the Hamilton Rating Scale for Anxiety total scores [mean difference = 3.31, 95% confidence interval(CI) 1.44-5.18, P = 0.0005], response [odds ratio(OR) = 1.83, 95%CI 1.58-2.12, P<0.00001], and remission (OR = 2.55, 95%CI 1.36-4.78, P = 0.003). In terms of tolerability, the most frequently reported treatment-emergent adverse events were nausea, dry mouth, dizziness, insomnia, somnolence, and headache. In addition, discontinuation due to all-cause (OR = 1.17, 95%CI 0.92-1.49, P = 0.19) was not significantly different between the two groups, whereas discontinuation due to adverse events was statistically higher in the venlafaxine XR group compared with the placebo treatment (OR = 2.80, 95%CI 2.21-3.54, P<0.00001) and discontinuation due to inefficacy was lower in venlafaxine than placebo treatment (OR = 0.26, 95%CI 0.17-0.40, P<0.00001). There was no significant publication bias and sensitivity analysis showed that our analysis exhibited high stability.
We concluded that venlafaxine XR (75-225 mg/day) is an effective and well-tolerated pharmacological treatment option for adult patients with GAD.
尽管在2002年和2004年之前的分析中已报道了文拉法辛缓释剂（XR）治疗广泛性焦虑症（GAD）的疗效，但样本量相当小，安全性或耐受性的评估尚不清楚。本分析具有样本量大的优势，并提供了耐受性的证据。
检索文献数据库，包括PubMed、Embase、Cochrane对照试验中央注册库、科学网和临床试验。最终选择了10篇符合条件的文章，并由两名独立作者提取数据并录入Review Manager 5.3。采用Cochrane协作网偏倚风险工具评估偏倚风险，通过敏感性分析评估结果的稳定性。使用Stata 12.0软件通过漏斗图和Egger/Begg检验评估发表偏倚。
在当前的荟萃分析中，分析了10篇（14项研究）符合纳入标准的文章。作为疗效结果，我们的研究结果表明，根据汉密尔顿焦虑量表总分的平均变化，文拉法辛XR比安慰剂显著更有效[平均差异=3.31，95%置信区间（CI）1.44-5.18，P=0.0005]、反应[比值比（OR）=1.83，95%CI 1.58-2.12，P<0.00001]和缓解（OR=2.55，95%CI 1.36-4.78，P=0.003）。在耐受性方面，最常报告的治疗中出现的不良事件是恶心、口干、头晕、失眠、嗜睡和头痛。此外，两组因各种原因停药（OR=1.17，95%CI 0.92-1.49，P=0.19）无显著差异，而文拉法辛XR组因不良事件停药在统计学上高于安慰剂治疗组（OR=2.80，95%CI 2.21-3.54，P<0.00001），文拉法辛组因无效停药低于安慰剂治疗组（OR=0.26，95%CI 0.17-0.40，P<0.00001）。没有显著的发表偏倚，敏感性分析表明我们的分析具有很高的稳定性。
我们得出结论，文拉法辛XR（75-225毫克/天）是成年GAD患者一种有效且耐受性良好的药物治疗选择。
